Clinical Study
Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study

https://doi.org/10.1016/j.jvir.2017.06.022Get rights and content

Abstract

Purpose

To compare transfemoral approach (TFA) and transradial approach (TRA) in patients undergoing hepatic chemoembolization in terms of safety, feasibility, and procedural variables, including fluoroscopy time, radiation dose (reference air kerma [RAK]), and patient preference.

Materials and Methods

A single-center prospective intrapatient comparative study was conducted with 42 consecutive patients with hepatic malignancies who received 2 consecutive treatment sessions of unilobar hepatic chemoembolization within a 4-week interval over a 6-month period with both TRA and TFA. All procedures were performed by 1 interventional radiologist who assessed the eligibility of patients for inclusion in the study. The primary endpoint was intraprocedural conversion rate. Secondary endpoints were access site complications, angiographic and procedural variables, and evaluation of patient discomfort and preferences.

Results

A 100% technical success rate and a crossover rate of 0% were recorded. There were no major vascular complications and similar rates of minor complications (4.8% for TRA, 7.1% for TFA; P = .095), which were self-limited and without any clinical sequelae. TRA treatments required a significantly longer preparation time for the procedure (P = .008) with no significant differences for other procedural variables. Greater discomfort at the access route and patient inability to perform basic activities after the procedure were recorded for TFA (P < .001). TRA was preferred by 35 patients (35/42) for potential future transarterial procedures.

Conclusions

TRA is safe and feasible for transarterial hepatic chemoembolization, with high technical success, low overall complications, and improved patient comfort.

Section snippets

Study Design

This study was a prospective, single-center, intrapatient comparison of TFA and TRA for patients with hepatic malignancies undergoing 2 consecutive chemoembolizations. The indication for treatments was based on a multidisciplinary tumor board evaluation. The study was conducted in compliance with the principles and protocols stated in the Declaration of Helsinki, in accordance with the International Conference on Harmonization Harmonized Tripartite Guideline for Good Clinical Practice. The

Results

Technical success of chemoembolization treatment sessions was obtained in all patients (100%). There was no switch from radial access to femoral access during any procedure (crossover rate 0%). Angiographic and procedural results are reported in Table 2. TRA treatments required a significantly longer preparation time for the procedure (P < .008); TRA procedures were also characterized by longer puncture, fluoroscopy, and total examination times, with higher mean radiation doses (RAK) and

Discussion

Recent literature demonstrated the superiority of TRA compared with TFA for percutaneous coronary interventions, reducing procedure-related bleeding complications and improving patient satisfaction 6, 7, 8. Despite the shift in access site preference among interventional cardiologists in favor of TRA, this technique is rarely used by interventional radiologists in the systemic circulation. In recent years, several articles suggested that TRA could be a valuable alternative to TFA for visceral

References (24)

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    If examination indicated the possibility of radial artery occlusion (RAO), ultrasound was performed to determine the patency status of the RA. The preparation and puncture times were defined as reported previously (10). The time of catheterization was determined from the time when the catheter was placed into the sheath until the catheter was positioned in the proper tumor feeding artery.

  • Society of Interventional Radiology Quality Improvement Standards on Radial Artery Access

    2021, Journal of Vascular and Interventional Radiology
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    The interest in TRA has been driven by multiple prospective randomized trials, meta-analyses, and retrospective cardiology studies demonstrating significant benefits of TRA compared to transfemoral access (3), including but not limited to: patient preference (4), decreased access site complications in general (5–8), and, for elderly patients (9,10), decreased overall complications and decreased mortality (11–14). Interventionalists in other specialties have been slower to adopt TRA, but recent publications by vascular surgeons (15–17), neurointerventionalists (18–22), and interventional radiologists (23–47) indicate that TRA is being used across a variety of procedures to treat many medical conditions outside of the heart. This quality improvement (QI) standard outlines the principles for performing TRA and has been developed for use in evaluating the outcomes of TRA in clinical practice.

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None of the authors have identified a conflict of interest.

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